Ren Yun-Yun, Li Xiao-Tian, Gui Yong-Hao, Yan Ying-Liu, Chang Cai, Zhang Jue-Hua, Sun Li, Zhou Yu-Qing, Kong Fan-Bin, Zhao Wei
Department of Prenatal Diagnosis Center, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.
Zhonghua Fu Chan Ke Za Zhi. 2008 Aug;43(8):589-92.
To assess prenatal heart disease screening program by ultrasound.
A total of 11,544 second-trimester screening scans were performed before 24 weeks' gestation on 11,410 women between February 2004 and May 2007 in Obstetrics and Gynecology Hospital of Fudan University. Fetal heart screening was based on four-chamber and outflow tract views (left ventricular outflow + three vessel view). The sensitivity and specificity of different views were evaluated. Follow-up data of newborns was obtained.
(1) Among 11,544 cases,48 cases of congenital heart disease (CHD) were diagnosed in utero. Six cases were false negative, and 2 cases were false positive. The incidence of CHD was 0.47% (54/11 544). (2) Thirty-three CHDs were detected based on the four-chamber view, including 18 ventricular septal defect (9 with conotruncal anomalies), 6 anomalous atrioventricle valve, 9 disproportion of left/right ventricle. The sensitivity of the four-chamber view alone was 61.11% (33/54), and the specificity was 99.98% (11 488/11 490). Fifteen CHDs were detected based on the left ventricular outflow and three vessel views, including 1 pulmonary atresia, 3 pulmonary valve stenosis, 2 transposition of the great arteries (TGA), 1 pulmonary stenosis with TGA, 6 tetralogy of Fallot, and 2 pulmonary stenosis. The sensitivity of the combination of the four-chamber and outflow tract views was 88.89% (48/54), and the specificity was 99.98% (11 488/11 490). (3) Of 48 CHDs, 11 cases were accompanied by other malformations. Eleven cases were performed amniocentesis, among whom 5 cases were trisomy 21.
The screening program based on four-chamber and outflow tract views shows good sensitivity and excellent specificity. Our prenatal heart screening program is clinically feasible.
通过超声评估产前心脏病筛查方案。
2004年2月至2007年5月期间，在复旦大学附属妇产科医院对11410名孕妇进行了共计11544次妊娠24周前的孕中期筛查扫描。胎儿心脏筛查基于四腔心切面和流出道切面（左心室流出道+三血管切面）。评估不同切面的敏感性和特异性。获取新生儿的随访数据。
（1）在11544例病例中，产前诊断出48例先天性心脏病（CHD）。6例假阴性，2例假阳性。CHD的发病率为0.47%（54/11544）。（2）基于四腔心切面检测出33例CHD，包括18例室间隔缺损（9例合并圆锥动脉干畸形）、6例房室瓣异常、9例左右心室比例失调。单纯四腔心切面的敏感性为61.11%（33/54），特异性为99.98%（11488/11490）。基于左心室流出道和三血管切面检测出15例CHD，包括1例肺动脉闭锁、3例肺动脉瓣狭窄、2例大动脉转位（TGA）、1例肺动脉狭窄合并TGA、6例法洛四联症和2例肺动脉狭窄。四腔心切面和流出道切面联合的敏感性为88.89%（48/54），特异性为99.98%（11488/11490）。（3）48例CHD中，11例伴有其他畸形。11例行羊水穿刺，其中5例为21-三体。
基于四腔心切面和流出道切面的筛查方案显示出良好的敏感性和出色的特异性。我们的产前心脏筛查方案在临床上是可行的。
